Modi Shivani K, Bhimineni Charishma, Rathod Malay, Palaferro Danielle, Dhamankar Minal
Internal Medicine, Einstein Medical Center Montgomery, East Norriton, USA.
Internal Medicine, Jefferson Einstein Montgomery Hospital, East Norriton, USA.
Cureus. 2024 Nov 27;16(11):e74587. doi: 10.7759/cureus.74587. eCollection 2024 Nov.
This case report presents the first known instance of pembrolizumab-induced autoimmune encephalitis in a 41-year-old female patient with stage IIIc triple-negative breast cancer. The patient developed expressive aphasia three days after starting pembrolizumab in combination with chemotherapy, prompting comprehensive evaluations that ruled out infectious or metastatic causes. A diagnosis of pembrolizumab-associated autoimmune encephalitis was established following a lumbar puncture and MRI. After discontinuing the immune checkpoint inhibitors (ICI) and initiating high-dose corticosteroids (methylprednisolone), the patient's symptoms significantly improved within days. This case highlights the importance of recognizing and managing neurological immune-related adverse events (irAEs) associated with ICIs, as their incidence can be variable but potentially severe. Clinicians must maintain a high index of suspicion for neurological irAEs, especially with new neurological symptoms, as early diagnosis and intervention are crucial for optimizing patient outcomes while balancing effective cancer treatment. Ongoing research is essential to elucidate the mechanisms and management strategies for ICI-related autoimmune encephalitis.
本病例报告介绍了首例已知的帕博利珠单抗诱发自身免疫性脑炎的病例，患者为一名41岁的IIIc期三阴性乳腺癌女性。该患者在开始使用帕博利珠单抗联合化疗三天后出现表达性失语，促使进行全面评估以排除感染或转移原因。在进行腰椎穿刺和磁共振成像（MRI）后，确诊为帕博利珠单抗相关的自身免疫性脑炎。在停用免疫检查点抑制剂（ICI）并开始使用大剂量皮质类固醇（甲泼尼龙）后，患者的症状在数天内显著改善。本病例强调了识别和管理与ICI相关的神经免疫相关不良事件（irAE）的重要性，因为其发生率可能各不相同，但可能很严重。临床医生必须对神经irAE保持高度怀疑，尤其是出现新的神经症状时，因为早期诊断和干预对于在平衡有效的癌症治疗的同时优化患者预后至关重要。持续的研究对于阐明ICI相关自身免疫性脑炎的机制和管理策略至关重要。
